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South Africa: AIDS Treatment Green Light
AfricaFocus Bulletin
Nov 23, 2003 (031123)
(Reposted from sources cited below)
Editor's Note
Last week the South African government approved a comprehensive
plan for treatment as well as prevention of HIV and AIDS. The
result of years of pressure by the Treatment Action Campaign (TAC)
and other activists, this step gives the green light for free
public treatment of all those in need of it. Implementing this
decision, however, still requires enormous efforts.
This issue of AfricaFocus Bulletin includes a statement by the
Treatment Action Campaign on the way forward, and excerpts from the
statement by the South African Cabinet.
"On behalf of the TAC National Executive, we wish to thank the
thousands of individuals and organisations, including TAC members,
MSF, the South African trade union movement, the churches, NGOs,
our funders and activists around the world, too numerous to name,
who have made these achievements possible." - TAC, November 20,
2003
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The Way Forward for the Treatment Action Campaign
20 November 2003
Treatment Action Campaign
http://www.tac.org.za
Dear TAC Volunteers, Members, Supporters, Allies and Friends
TAC Welcomes Cabinet Adoption of Treatment Plan
Decision Gives Hope to Poor Communities Across South Africa
The South African Cabinet has approved the Operational Plan for
Comprehensive Treatment and Care for HIV and AIDS. The plan
envisages that "within a year, there will be at least one
[antiretroviral] service point in every health district across the
country, and within five years, one service point in every local
municipality." [Cabinet Statement, 19 November 2003]. The plan also
commits government to investing substantial finance into "upgrading
our national healthcare system" via "recruitment of thouands of
professionals and a very large training programme to ensure nurses,
doctors, laboratory technicians, counsellors and other health
workers have the knowledge and the skills to ensure safe, ethical
and effective use of medicines." Government has also committed to
a massive public education campaign, improved prevention efforts
and improved treatment of opportunistic infections.
The Treatment Action Campaign (TAC) welcomes the Cabinet decision.
This is a wonderful day for all in South Africa. There is now real
hope for millions of people with HIV and their families. It is
tragic that for many people this decision has come much too late,
such as a founding member of TAC's Samora branch in Cape Town who
died of AIDS today.
The challenges ahead for all of us are to ensure that the plan is
implemented as speedily as possible and to mobilise our communities
around counselling, testing and understanding how treatment works.
Critically, we need to develop and implement more sophisticated
prevention messages.
We urge government to release the full treatment plan so that civil
society can study its details and assist with its implementation.
The Cabinet Statement and a Question and Answer document on the
Operational Plan handed out by government are [available at:
[http://www.gov.za/issues/hiv/cabinetaidsqa19nov03.htm]
The Way Forward for the Treatment Action Campaign
Nearly five years after the launch of the TAC, we have reached a
crucial turning point in our struggle. We stand on the brink of the
implementation of a treatment plan that has the potential to save
millions of lives. This is what we have worked for since the TAC
began. It is therefore a good opportunity to examine what the TAC
has achieved and what the way forward is.
Together with our allies in South Africa and internationally we
have successfully changed our government's policy, challenged the
power of the pharmaceutical industry and made many important
international organisations and governments realise that people
with HIV/AIDS in poor countries have a right to have access to
medicines and must be treated with dignity.
On behalf of the TAC National Executive, we wish to thank the
thousands of individuals and organisations, including TAC members,
MSF, the South African trade union movement, the churches, NGOs,
our funders and activists around the world, too numerous to name,
who have made these achievements possible.
We also pay tribute to our many comrades who died because of HIV
before we reached this turning point.
You can all feel justly proud that your immense efforts, to build
a more equitable and just world, have been worthwhile.
The combination of the Constitutional Court decision on
mother-to-child transmission prevention, the Stand Up for Our Lives
march in February, the civil disobedience campaign and the
international protests around the world have convinced Cabinet to
develop and implement an antiretroviral rollout plan.
But government must do much more including implementing better
prevention programmes, better opportunistic infection treatment and
greatly improved work-conditions for health-care workers. We also
need clear messages of support for prevention and treatment from
President Mbeki and all Cabinet ministers. We have come a long way
but we must be ready to put more pressure on government if it does
not implement the treatment plan properly.
Hundreds of our members across the country live openly with HIV.
They tell their friends, family and work colleagues they have HIV.
They even say it in newspapers, on radio and on television. Our
HIV-positive t-shirt, a sign of openness and solidarity, is worn by
thousands of people.
Nevertheless, many people with HIV still experience discrimination
and cannot be open. We still have much to do to create openness.
Before we began our campaign, antiretrovirals cost over R4,000 per
month. Patented antiretrovirals now cost about R1,000 per month.
TAC, MSF and GARPP also purchase generic antiretrovirals, in breach
of patent, at R300 or less per month. The deal announced by the
Clinton Foundation will bring the prices of generic antiretrovirals
down to less than R90 per month for government.
We still cannot get these generic medicines, but our pressure on
the drug companies through the Competition Commission will surely
succeed in the near future.
A few years ago, the dominant view was that prevention of HIV was
all that was necessary for the developing world. This has changed.
UNAIDS, the European Union and the United States now say that
treatment is critical. The Global Fund has been established to help
poor countries improve their health care systems so that AIDS, TB
and malaria can be treated. Furthermore, HIV/AIDS activism is
taking route in many African countries strengthened by the
Pan-African Treatment Access Movement.
The global political will to treat people in poor countries is
unprecedented.
Where to from Here for the TAC
The TAC's struggle is seen as a model by many organisations and
people in South Africa and across the world because of the
commitment we demonstrate and our ability to mobilise poor people
across the country. Although we can be proud of this, we should
also be careful because the expectations upon us are enormous. We
must not become complacent because this can easily lead to errors
which will destroy the good reputation and work of the TAC. We must
live up to the expectations upon us that are realistic. After five
years of struggle and the loss of many comrades to AIDS, most of us
are tired. We must rest but there is hard work ahead.
The success of the treatment plan rollout depends on our ability to
mobilise our communities. Because of this fact, we are going to
focus much of our energy at the level of the District Health
Service. We are going to assist with service delivery but keep up
our pressure through mobilisation and demonstrations when needed.
Branches must work with clinics and campaign for their problems to
be rectified. For this to succeed, TAC structures have to function
better than ever and our understanding of treatment literacy must
improve.
Finally, we will keep up our capacity to mobilise at a national and
international level. There are still people high in our government
who oppose a treatment plan and will try to delay the rollout of
antiretroviral therapy. Pharmaceutical companies will continue to
try to profiteer from medicine. Laboratory costs have not yet come
down sufficiently. We will have to monitor all of these things
closely and be able to apply pressure when needed. The TAC is not
going away.
Making Our Structures Work
Each structure has a clear mandate of what is expected from it.
Our provincial offices must ensure that each district has the
resources they need to perform their duties. We must ensure that
people of all races participate in our provincial activities. NGOs,
religious organisations and unions must continue to be involved in
our work.
Our district committees are responsible for the functioning of TAC
branches within their jurisdiction. Every TAC district should have
at least 30 activists who are trained on treatment literacy to be
able to educate their own communities.
Each branch should have an outdoor and indoor programme. The indoor
one should include workshops on improving clinics in the branch
area, antiretrovirals, opportunistic infections, social grants and
prevention. The outdoor one should involve pamphleteering, public
speaking and door-to-door campaigns. Critically, we need to learn
to use the clinic checklist and to work with our clinics so that we
can improve them.
Comrades from different areas must understand their
responsibilities and be visible in their communities. We must
understand our provincial government's rollout plans so we can
intensify our treatment literacy and openness campaigns in clinics
where antiretroviral therapy is implemented.
Many clinics will not implement antiretroviral therapy immediately.
We need to get those clinics ready so that they can begin
treatment. This means we must make sure that they have enough
nurses and doctors who are properly trained on HIV/AIDS. HIV and
CD4 tests must be available. Appropriate medicines must be given to
patients with opportunistic infections. There must be high-quality
counselling, including information on safer sex. Condoms must be
distributed at all clinics.
Here are some things to be done:
- TAC meetings must be held in every district to brief activists
about our role in the rollout.
- Every provincial office must assess the role TAC is playing in
the existing pilot programmes and what lessons could be learnt in
order to prepare us for the rollout.
- District general meetings should be held every month to brief
organisations of the progress made and how they can help.
- HIV support groups groups must be challenged to work with the
TAC to address stigma and improve clinic services.
- We need to work closely with government institutions
distributing food parcels and help speed up delivery of this
programme.
- Social Grant education should be done at branch level and in
support groups and form part of our door-to-door campaigns.
- We must organise events at district level to keep people
mobilised and ensure that we deal with stigma and discrimination.
- The TAC Treatment Project must be integrated into the activities
of the TAC, especially the wellness programme, so that our
activists with HIV can stay healthy. By integrating the TAC and the
Treatment Project we will also assist the treatment plan rollout.
- TAC people should speak at public forums and create more
awareness about the challenges lying ahead and the solutions.
- Volunteer exchange programmes between branches, districts and
provinces will help activists to exchange knowledge and skills to
better equip us for the challenges ahead.
We have come a long way and achieved magnificent successes, but the
hardest work is ahead of us. Let us mobilise for the treatment plan
rollout. A luta Continua!
Yours in the struggle for health and human rights
Mandla Majola, Sipho Mthathi, Mark Heywood and Zackie Achmat
On Behalf of the TAC National Executive Committee
20 November 2003
[END OF LETTER]
Cabinet statement on treatment plan for HIV and AIDS
19 November 2003
[Presented by Minister of Health, Dr Manto Tshabalala-Msimang]
Issued by: Government Communication and Information System (GCIS)
For further enquiries contact: Joel Netshitenzhe 082 900 0083
[Excerpts only: the full document is available at:
http://www.gov.za/issues/hiv/cabinetaidsqa19nov03.htm]
Cabinet today in principle approved the Operational Plan for
Comprehensive Treatment and Care for HIV and AIDS, which it had, on
8 August this year, requested the Department of Health to prepare.
Amongst other things, the Plan provides for Anti-retroviral
Treatment in the public health sector, as part of the government's
comprehensive strategy to combat HIV and AIDS.
The meeting instructed the Department of Health to proceed with
implementation of the Plan.
It is envisaged in the Plan that, within a year, there will be at
least one service point in every health district across the country
and, within five years, one service point in every local
municipality. Some areas will be able to start sooner than others,
and the Department of Health will keep the public informed of the
progress of the rollout.
These service points will give citizens access to a continuum of
care and treatment, integrated with the prevention and awareness
campaign which remains the cornerstone of the strategy to defeat
HIV and AIDS.
Concretely this far-reaching decision of government will mean:
- Stepping up the prevention campaign so that the 40 million South
Africans not infected stay that way
- A sustained education and community mobilisation programme to
strengthen partnership in the fight against the epidemic
- Expanding programmes aimed at boosting the immune system and
slowing down the effects of HIV infection, including the option of
traditional health treatments for those who use these services
- Improved efforts in treating opportunistic infections for those
who are infected but have not reached the stage at which they
require antiretrovirals
- Intensified support for families affected by HIV and AIDS
- Introduction of antiretroviral treatment for those who need it,
as certified by doctors
BUILDING CAPACITY
To deliver this kind of care across the country, with equitable
access to all, will require a major effort to upgrade our national
healthcare system. This includes the recruitment of thousands of
health professionals and a very large training programme to ensure
that nurses, doctors, laboratory technicians, counsellors and other
health workers have the knowledge and the skills to ensure safe,
ethical and effective use of medicines. ...
Over half of the total budget that will be spent over the next five
years in implementing this programme will go to upgrading health
infrastructure, emphasising prevention and promoting healthy
lifestyles. As such, the implementation of this plan will benefit
the health system as a whole.
Cabinet agreed that the funds allocated for this programme should
be "new money". The programme will and must therefore not detract
from other programmes of health care and provision of social
services. ...
CENTRALITY OF PREVENTION
Government wishes to reiterate that there is no known cure for
AIDS. We cannot therefore afford, as a nation, to lower our guard.
Prevention therefore remains the cornerstone of our campaign.
The eradication from the body of the HIVirus remains beyond reach.
The mechanisms of HIV infections remain difficult to fathom, and
the downhill plunge of the infected, to severe immune deficiency
over the next 2-14 years is ill-understood. The co-factors that are
thought to mitigate immune destruction of healthy CD4+ cells by the
minority of infected CD4+ are still uncharacterised. In the South
African context the immune systems is assaulted by a host of
factors related to poverty and deprivation.
The Operational Plan places a high premium on strengthening
prevention efforts and it underlines the critically important
messages of prevention and of changing lifestyles and behaviour.
These elements of our Comprehensive Strategy remain the starting
point in managing the epidemic.
At the same time, it should be noted that not everyone who is HIV
positive requires Anti-retroviral Treatment. As such, the plan also
provides for enhanced care for those who are infected but have not
as yet progressed to an advanced stage of AIDS.
At the same time, the challenges of home-based care, the campaign
to combat discrimination against those who are infected and
affected remain critical. So is the task of intensifying efforts to
deal broadly with poverty and poor nutrition.
STRENGTHENING PARTNERSHIPS
Progress in implementing the Plan adopted by government today will
depend, to a significant degree, on intensified mobilisation across
society. Besides the legion of non-governmental and community-based
organisations who are involved in constructive work in this regard,
the media is an important partner, as it has the potential to
communicate messages of awareness and hope, and to keep the nation
accurately informed about the campaign against HIV and AIDS.
A cooperative relationship among all sectors of society,
particularly in the implementation of this element of the
comprehensive strategy, the spirit of letsema and vuk'uzenzele, a
message of hope and responsibility as well as constructive
engagement in the realm of practical work will ensure that South
Africa advances even more decisively in this endeavour.
The Comprehensive Plan for Treatment and Care carves out a future
for those infected with HIV, and for those suffering from immune
deficiency; whilst assisting the vast majority of South Africans
who are HIV negative to remain that way. The peculiarly South
African nature of the problem demands South African solutions;
solutions contained within this complex and detailed Comprehensive
Plan for Treatment and Care.
Such an ambitious goal - targeting the immense complexity of the
human immune system operating within the environmental milieu of
Africa - predicates a multifaceted, integrated and intersectoral
response in prevention, treatment and care. The Plan is the final
piece completing the jigsaw puzzle of the National Strategic Plan
for HIV and AIDS 2000 - 2005 whose four key areas of intervention
were: prevention, treatment, care and support; research, monitoring
and surveillance; as well as legal and human rights.
CONCLUSION
Cabinet wishes to express its appreciation of the work done by
members of the Task Team - including in particular experts and
specialists from inside and outside the country - whose
contribution has helped shape this Plan. We are confident that, as
with our national prevention efforts, this Plan will rank among the
most comprehensive in the world.
Government is once more strengthening the hand of the nation in the
fight against HIV and AIDS, in keeping with its mandate to build a
better life for all. If correctly implemented this Operation Plan
provides an excellent opportunity to complete the treatment sector
of the National Strategic Plan for HIV and AIDS whilst also
strengthening prevention. The challenge is immense but not
impossible.
We are confident that, together, bound by a people's contract for
a better life, we shall all continue to make progress in building
South Africa into a land our dreams.
There is hope!
AfricaFocus Bulletin is a free independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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